Provider Demographics
NPI:1679052393
Name:JARRETT, CYNTHIA WATTS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:WATTS
Last Name:JARRETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 LAKEHALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6091
Mailing Address - Country:US
Mailing Address - Phone:662-820-3707
Mailing Address - Fax:
Practice Address - Street 1:677 LAKEHALL RD
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6091
Practice Address - Country:US
Practice Address - Phone:662-820-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1008225100000X
ARPT538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist